Category: reparative therapy

Reparative therapy and confirmation bias: Langer & Abelson’s 1974 study of clinical bias

Recently, I have been examining the possible role of confirmation bias in the attributions of reparative therapists.  In this post, I look at a classic study of how theoretical persuasion associates with clinical judgment.

Ellen Langer’s and Robert Abelson’s 1974 study* on clinical judgment is an important caution to clinicians about the role of preconceived ideas on diagnosis and attributions about patients. The abstract for the study is presented here:

The effect of labels on clinicians’ judgments was assessed in a 2 X 2 factorial design. Clinicians representing two different schools of thought, behavioral and analytic, viewed a single videotaped interview between a man who had recently applied for a new job and one of the authors. Half of each group was told that the interviewee was a “job applicant,” while the remaining half was told that he was a “patient.” At the end of the videotape, all clinicians were asked to complete a questionnaire evaluating the interviewee. The interviewee was described as fairly well adjusted by the behavioral therapists regardless of the label supplied. This was not the case, however, for the more traditional therapists. When the interviewee was labeled “patient,” he was described as significantly more disturbed than he was when he was labeled “job applicant.”

In addition to ratings of pathology, the authors recorded some of the descriptions of the interview by therapists who were told the interviewee was a job applicant and those who were told he was a patient. The differences are striking. Behavior therapists did not differ much but the psychoanalytic therapists described the job applicants as well adjusted but the same interviewee, when labeled as a patient, was labeled as disturbed. Note these differences from Langer and Abelson’s discussion of their study.

In the study just described, all of the subjects saw the same videotaped interview. Yet when asked to describe the interviewee, the behavior therapists said he was “realistic”; “unassertive”; “fairly sincere, enthusiastic, attractive appearance”; “pleasant, easy manner of speaking”; “relatively bright, but unable to assert himself”; “appeared responsible in interview.” The analytic therapists who saw a job applicant called him “attractive and conventional looking”; “candid and innovative”; “ordinary, straightforward”; “upstanding, middle-class-citizen type, but more like a hard hat”; “probably of lower or blue-collar class origins”; “middle-class protestant ethic orientation; fairly open-— somewhat ingenious.” The analytic therapists that saw a patient described him as a “tight, defensive person . . . conflict over homosexuality”; “dependent, passive-aggressive”; “frightened of his own aggressive impulses”; “fairly bright, but tries to seem brighter than he is … impulsivity shows through his rigidity”; “passive, dependent type”; “considerable hostility, repressed or channeled.”

Note the dramatic differences in descriptions. The same person who was described as well adjusted by analysts who thought they were watching a person applying for a job was described in pathological terms when they thought they were watching a patient being interviewed. Note that an attribution of homosexuality was made by at least one of the analytic therapists.

When reparative therapists say they are not biased when examining the histories of their same-sex attracted patients, I am highly skeptical.

Langer and Abelson describe the potential problem with making attributions based on patient labeling:

In practical terms, the labeling bias may have unfortunate consequences whatever the specific details of its operation. Once an individual enters a therapist’s office for consultation, he has labeled himself “patient.” From the very start of the session, the orientation of the conversation may be quite negative. The patient discusses all the negative things he said, did, thought, and felt. The therapist then discusses or thinks about what is wrong with the patient’s behavior, cognitions and feelings. The therapist’s negative expectations in turn may affect the patient’s view of his own difficulties, thereby possibly locking the interaction into a self-fulfilling gloomy prophecy.

It is not hard to see how a client presenting with “unwanted same-sex attraction” could end up in the kind of self-fulfilling prophecy described by Langer and Abelson. Since reparative therapists believe homosexuality is invariably caused by “gender wounds” early in life, no small amount of effort will be spent to find evidence of them, whether or not they exist.

*Langer, E.J.; & Abelson, R.P. (1974).A patient by any other name . . . : Clinician group difference in labeling bias.Journal of Consulting and Clinical Psychology.42(1), 4-9.

Related:

 

 

Reparative therapy and confirmation bias: An illustration

One of the biggest problems I have with reparative therapy is the self-fulfilling nature of the approach. Reparative therapists assume that the existence of same-sex attraction means a person has suffered gender based trauma during a specific period of childhood.

Reparative therapist David Pickup has commented on another post that straight men may have wounds but, from his point of view, they are not as deep as those which haunt gay men. In other words, if a straight man says he was traumatized in the same way, the reparative therapist’s answer is that the trauma wasn’t deep enough to trigger the reparative drive leading to same-sex attraction. If the gay man says he does not recall any such trauma, then the reparative drive theory posits that the gay man has repressed it and needs to uncover it. It seems to me the powerful effects of confirmation bias are at work.

The assumptions necessary to work as a reparative therapist remind me of the assumptions often associated with the repressed memory movement. Especially during the decade of the 1990s, many therapists assumed that negative moods such as depression or relational problems were due to childhood abuse of some kind that had been forgotten via the defense mechanism of repression. Some therapists harbored a belief that clients who could not remember trauma from the past were in a state of denial. This belief  led some therapists to repeatedly ask about recollections of trauma and hold out the possibility to their clients that they were simply unable to remember.

By questioning the mechanism of repression, I am not questioning the reality of gender based trauma. I am not questioning that some gay people had very impoverished childhoods. Of course that is true. But so did many straight people. In his recent comment, Mr. Pickup proposed that gay people have experienced deeper trauma than straight people experienced. This seems circular to me. How can you tell which experiences are worse? As far as I can tell, the way reparative therapists answer this question iss by knowing the sexual orientation of the client. Straight people have deep wounds; gay people, by definition according to the reparative approach, have deeper wounds.

As an illustration of how clients can adapt themselves to the theories of their therapists, I offer the experience of Carol Diament. Ms. Diament initially thought she would not need to detach from her family, as the other clients at Genesis Associates did. However, after awhile, “memories of abuse came up” and she detached from her parents (over three years), husband and even small children (at least 8 months and maybe longer).

Eventually Carol got away from Genesis, sought another therapist and came to realize that her memories were reconstructed with the help of her therapists at Genesis. By then, the damage was done. She had lost years of her life and had even lost her immediate family.

The clip is just over nine minutes long, but I hope you will watch it all the way through. Then, I hope you will discuss this and let me know what you think. Am I seeing a parallel with reparative theory that is valid or not?

Over the years, I have worked with many clients, gay and straight, who have experience significant trauma with parents. However, I have not been able to differentiate them based on the severity of their experiences. Furthermore, I know and have worked with many gay men and women who recall no deep trauma relating to their parents or peers. I also know gay men who experienced trauma after they came out to their parents because of the tension surrounding homosexuality. However, prior to the disclosure, the relationship was on par with any comparable straight person’s home life.

I also want to be clear that I am not closed to the possibility that certain childhood experiences could influence some people to question sexuality and engage in same-sex behaviors. In addition, some experiences of abuse are associated with risky sexual behavior of all kinds. Therapy, even reparative therapy, might help such people. However, I think these scenarios represent only a portion (probably very small) of the total gay and bisexual population.

NARTH issues statement on sexual orientation change

Apparently in response to Alan Chambers’ candor about sexual orientation change, the National Association for the Research and Therapy of Homosexuality issued a clarification of what that organization means by change.

Issued January 27, the statement reads in full:

Current discussions of homosexual sexual orientation change are unavoidably occurring within a sociopolitical climate that makes nonpartisan scientific inquiry of this subject very difficult.  In light of this reality, a few considerations are crucial for accurately understanding the sometimes contradictory opinions regarding the possibility of sexual orientation change.   First and foremost, it is important to recognize that how change is conceptualized has vast implications for our thinking about change.  Some of the more ardent proponents and opponents of homosexual sexual orientation change may view change in strictly categorical terms, where change is an all-or-nothing experience.  Proponents and opponents with this view differ only in the direction of their desired outcome.  Proponents of change understood in categorical terms may view a homosexual sexual orientation as a lifestyle choice that merely needs to be renounced. Opponents who take this viewpoint, on the other hand, may conceive of sexual orientation as essentially hard wired and simply not modifiable.  NARTH does not support either of these perspectives.

NARTH believes that much of the expressed pessimism regarding sexual orientation change is a consequence of individuals intentionally or inadvertently adopting a categorical conceptualization of change. When change is viewed in absolute terms, then any future experience of same-sex attraction (or any other challenge), however fleeting or diminished, is considered a refutation of change. Such assertions likely reflect an underlying categorical view of change, probably grounded in an essentialist view of homosexual sexual orientation that assumes same-sex attractions are the natural and immutable essence of a person.  What needs to be remembered is that the de-legitimizing of change solely on the basis of a categorical view of change is virtually unparalleled for any challenge in the psychiatric literature.  For example, applying a categorical standard for change would mean that any subsequent reappearance of depressive mood following treatment for depression should be viewed as an invalidation of significant and genuine change, no matter how infrequently depressive symptoms reoccur or how diminished in intensity they are if subsequently re-experienced.  Similar arguments could be made for any number of conditions, including grief, alcoholism, or marital distress.  The point is not to equate these conditions with homosexuality, but rather to highlight the inconsistency of applying the categorical standard only to reported changes in unwanted same-sex attractions.

Rather than pigeonholing homosexual sexual orientation change into categorical terms, NARTH believes that it is far more helpful and accurate to conceptualize such change as occurring on a continuum.  This is in fact how sexual orientation is defined in most modern research, starting with the well known Kinsey scales, even as subsequent findings pertinent to change are often described in categorical terms. NARTH affirms that some individuals who seek care for unwanted same-sex attractions do report categorical change of sexual orientation.  Moreover, NARTH acknowledges that others have reported no change. However, the experience of NARTH clinicians suggests that the majority of individuals who report unwanted same-sex attractions and pursue psychological care will be best served by conceptualizing change as occurring on a continuum, with many being able to achieve sustained shifts in the direction and intensity of their sexual attractions, fantasy, and arousal that they consider to be satisfying and meaningful. NARTH believes that a profound disservice is done to those with unwanted same-sex attractions by characterizing such shifts in sexual attractions as a denial of their authentic (and gay) personhood or a change in identity labeling alone.  Attempts to invalidate all reports of such shifts by presuming they are not grounded in actual experience insults the integrity of these individuals and posits wishful thinking on an untenably massive scale.

Finally, it also needs to be observed that reports on the potential for sexual orientation change may be unduly pessimistic based on the confounding factor of type of intervention.  Most of the recent research on homosexual sexual orientation change has focused on religiously mediated outcomes which may differ significantly from outcomes derived through professional psychological care.  It is not unreasonable to anticipate that the probability of change would be greater with informed psychotherapeutic care, although definitive answers to this question await further research.  NARTH remains highly interested in conducting such research, pursuant only to the acquisition of sufficient funding.

To summarize, then, those who are  highly pessimistic regarding change in sexual orientation appear to have assumed a categorical view of change, which is neither in keeping with how sexual orientation has been defined in the literature nor with how change is conceptualized for nearly all other psychological challenges.  NARTH believes that viewing change as occurring on a continuum is a preferable therapeutic approach and more likely to create realistic expectancies among consumers of change-oriented intervention.  With this in mind, NARTH remains committed to protecting the rights of clients with unwanted same-sex attractions to pursue change as well as the rights of clinicians to provide such psychological care.

I hope to post something on this Monday or Tuesday; but for now here is NARTH’s official word on the subject of orientation change. Discuss…

NARTH at odds with Exodus over reparative therapy

Historically, the National Association for the Research and Therapy (NARTH) has considered Exodus an ally in the social discussion of sexual orientation change efforts. Until recently, Exodus sold reparative therapy books in their bookstore but recently removed them. Also, Alan Chambers recently told an audience at the Gay Christian Network conference that

The majority of people that I have met, and I would say the majority meaning 99.9% of them have not experienced a change in their orientation or have gotten to a place where they could say that they could  never be tempted or are not tempted in some way or experience some level of same-sex attraction.

I asked Alan Chambers about the reason for the removal of the reparative therapy books and he told me that Exodus wants to be clear that Christian discipleship is how they want to be known. He also said that he has respect for reparative therapy observations but added

The reason I removed RT books from Exodus Books is because I don’t agree with using this research as a means to say that “this” is how homosexuality always develops, “this” is the primary means in which to deal with it and this is “the” outcome you can expect.  Too, Exodus, as a whole, is not a scientific or psychological organization…we are a discipleship ministry and that is where I think our strength is and energy should be focused.

Apparently, these developments are troubling to NARTH leaders. One of them, David Pickup, recently penned an article at the Anglican Mainstream in defense of reparative therapy.  He wrote the article in direct response to the comments by Alan Chambers, noted above. Pickup writes:

Authentic Reparative Therapy really works. It works to help men change their sexual orientation, naturally dissipate their homoerotic feelings, and maximize their heterosexual potential.

However, there is evidence from the Exodus ministry that could be signaling an unawareness of this important message. Exodus has indicated a significant change in their views and policies as evidenced by the remarks of Exodus President Alan Chambers at the Gay Christian Network Conference last week. The official commentary on the peter-ould.net website has brought this to our attention. I believe their interpretation of Alan Chamber’s remarks is correct.

Chambers’ remarks essentially indicate that:

1. Exodus will no longer indicate or specifically claim that change from Gay to 100% straight is possible for anyone except for a few rare cases.

2. Exodus has apologized and will continue to do so for making these unrealistic claims, which they now believe have contributed toward misinformation, hurtfulness and homophobia.

3. Exodus will work to achieve a deeper understanding of the truth of homosexuality, which will allow them to minister more effectively and compassionately to those dealing with homosexuality.

Pickup then says something that will leave Exodus and NARTH watchers in disbelief.

In my experience, Exodus has, quite unintentionally for the last 20 years, failed to understand and effectively deal with the actual root causes of homosexuality and what leads to authentic change. I laud their willingness to admit their naiveté’, but I do not see anything so far that indicates they now truly understand the psychological, developmentally-based causes of homosexuality or what produces real change.

According to Pickup, not only is Exodus clueless now, they have been for 20 years. I imagine that will come as a shock to those in Exodus who have been given talks straight out the reparative playbook for all those years.

Pickup then offers his slant on why change in orientation should be recognized even if a same-sex attracted person is still same-sex attracted after they say they have changed.

(Parenthetically, let me state it is important that we recognize that just because a man might feel occasional sexual attractions towards men does NOT mean significant and real change has not occurred. Let’s take other challenges common to many people: depression or anxiety for instance. How many people who have successfully dealt with these issues are 100% changed so that they are not susceptible to later feelings of depression or anxiety? Can a therapist guarantee a client will never have those feelings again? Of course not. The same is true for homosexuality. Real change has occurred; however, no apologies should be made if much successful change has occurred even though homosexual feelings occasionally surface.)

I asked Alan Chambers what he meant by saying “99.9” don’t change and he said:

I cannot speak for others who say that temptation or attraction don’t equal orientation.  As a layman with regards to that issue, I tend to link them all together and that is where that 99.9%, non-scientifc/anecdotal/experiential statement comes from.

So what does it matter if some same-sex attraction remains? Doesn’t even a little shift deserve the word change attached to it? Alan seems to want to extract himself from this semantic debate by sticking to experience – the vast majority of people he knows retain attractions to the same sex. Pickup wants to explain that away by making sexual attraction analogous to depression or anxiety. Since he sees same-sex attraction as a disorder which stems from childhood wounds, that may work for him, but it won’t work for those who do not see it that way.

One problem here is political. NARTH wants to be able to say SSA people have changed if they experience a reduction in awareness of SSA and perhaps an experience of opposite sex attraction. This is a kind of change and if left in the therapeutic context, I would not quarrel too much with this (except to say that I don’t agree with the kind of techniques often used to push people this way). However, NARTH does not stay in the therapeutic context. They provide support for political groups who want change to mean complete change from gay to straight. Change is such a volatile concept because a modicum of change in the therapeutic setting is then exaggerated in the political and legal settings to argue against same-sex attraction as something intrinsic to the vast majority of people who experience it.

Pickup then lectures Exodus about theology and calls on them to align closer with reparative therapists.

If Chambers and Exodus do want to truly understand the nature of homosexuality, then they should be open to understanding the psychological underpinnings of these issues and start to recommending qualified therapists who are experts at facilitating significant change. If not, then Exodus will fall into deeper controversy than they are in already. They will be reduced to the myopic ministry of simply helping people to deal with their homosexuality through behavioral changes, which, by the way, reflects the American Psychological Association’s belief about Reparative Therapy: that real change is not possible and people may be helped only in the sense of conforming their behavior to reflect their religious beliefs. In short, Exodus will eventually lose even more effectiveness and begin to flounder.

Pickup even claims that reparative therapy is biblical:

Generally, many Exodus members cannot or will not see that Reparative Therapy is reflective of sound biblical principles. They do not understand shame and its role in the etiology of homosexuality. Not knowing this has led to the unintentional shaming of many same-sex attracted individuals for years, and has actually impeded their progress!

So Exodus has been part of the problem all these years?! I have been to several Exodus conferences over the years, and I can say they work hard not to shame people. The only sessions where I heard any shaming take place was in the sessions where reparative therapists told their audiences that the reason they were SSA was because their fathers didn’t love them and their mothers were smother mothers.

After chastising Exodus for shaming people, he engages in the practice by blaming parents and indicting parents and churches for causing the gay.

Many people of faith do not understand the root causes of homosexuality, which are primarily experienced in childhood. If they did understand, they would have to deal with the truth that they may have contributed to the development of their child’s homosexuality by not supplying enough of their emotional and identity formation needs. In general, parents find it very hard to believe how their child’s upbringing could possibly have been so injurious to them since they loved their child so much. However, loving a child and giving the child the love he needs can be two entirely different things. Parents and churches often find this idea to be unbelievable.

All I can say to Pickup’s last sentence there is: if only. If it were true that evangelicals were more skeptical of these ideas, then I believe Exodus would have changed the tune a long time ago. If only evangelicals were more skeptical, we would not be in such a polarized society where Christianity is synonymous with anti-gay.

As if a few anecdotes prove anything, Pickup closes by citing come quotes he says come from satisfied change customers.

“This is really hard work, but when I focus on healing the pain of what I didn’t get from my father or my friends, something in me heals. Then when I get my male needs met, the SSA just goes away by itself.”

“I really feel more attracted to women now. I want to love a woman and have a family.”

“I still have shame issues, and I once in a while feel attracted to a man, but I know how to work on that and feel affirmed by other men now.” I see myself as a man like other men, and the sexual attractions just sort of go away.”

“This affirmation work and the needs I’m getting filled feels a lot better than sex with a guy.”

I have no doubt that healing from real wounds in life can be beneficial emotionally and it can also lead to a better sense of self-control. So when people who are sexually compulsive find some way to understand themselves better, they can resist whatever pressures push them to risky behavior. However, as Alan Chambers recently noted, such benefit infrequently leads to an elimination of same-sex attraction.

Now if four quotes are sufficient for Mr. Pickup, I will end with four statements from my clients about reparative therapy and their experience.

Our therapist told us after taking our money that there was nothing he could do for us because our family didn’t fit the typical family for a homosexual. He even said that our son would grow out of it because we didn’t fit the mold. (He didn’t grow out of it)

I quit going to Journey into Manhood because it just didn’t last. After a weekend, I did lose some of the same-sex attraction but it always came back. I went to a support group, and saw a reparative therapist and it just didn’t change.

When we took our son to the reparative therapist, he told us that same-sex attraction invariably arises due to a broken relationship with me, his father, and a mother who compensates for this. We were devastated; the man said he was describing our family but he was wrong. My son and I have always been close.

You know, I used to want to change my attractions. I felt like a failure when I saw a hot guy. But the last 3 years have been awesome, I don’t have to pretend or anything. I am who I am and that is an SSA man who loves his wife and kids.

I believe it is possible that Pickup’s clients find an adjustment that suits them. However, the mischief starts when reparative therapists generalize those experiences to gay people as a group.

I am sure it obvious that I think Chambers is much more on the right track than Pickup. Although Exodus continues to refer to reparative therapists and there are member ministries that are quite reparative in their approach, I think a move toward honesty about what people can expect is valuable.

Alan Chambers: 99.9% have not experienced a change in their orientation

As noted Friday, President of Exodus International, Alan Chambers, spoke that evening as a part of a panel discussion at the annual conference of the Gay Christian Network.  Audio of the panel is now up at GCN (Part 1, part 2). During part 2, about 5:30 into the file, Alan Chambers is asked, I think by GCN Executive Director Justin Lee,  about the way Exodus and member ministries describe the work they do. Specifically, Lee asked about the slogan “change is possible.” Chambers responds by discussing his views of sexual orientation change, saying

The majority of people that I have met, and I would say the majority meaning 99.9% of them have not experienced a change in their orientation or have gotten to a place where they could say that they could  never be tempted or are not tempted in some way or experience some level of same-sex attraction. I think there is a gender issue there, there are some women who have challenged me and said that my orientation or my attractions have changed completely. Those have been few and far between. The vast majority of people that I know will experience some level of same-sex attraction.

There was also some discussion of change meaning a change of viewpoint and behavior but the consensus was that Chambers was giving an honest appraisal of the aspect of sexuality that involves essential attractions. As one who once defended sexual reorientation change efforts, I have to agree with Chambers’ assessment. Credible reports of change are rare and do come more often from women than men.

Now, I wonder. Will this news be reported by Christian media, or become part of the evangelical blackout?